Epilepsy and The Pharmacist

1
Epilepsyand The Pharmacists Rôle

• Miriam Wilcher
• Retired Lead Pharmacist for PLD
• For Birmingham
• Greenfields Birmingham B30 3QQ

2
Epilepsy and PLD

• PLD have a high incidence of epilepsy
• Many have serious physical problems
• Pharmacy is involved as part of the
  multidisciplinary team to promote a good quality
  of life

3
Problem Areas

• Most people with epilepsy are managed in the
  community, rarely managed as in-patients.
• Many patients find it difficult to appreciate the
  need to have regular medication to prevent
  seizures.
• Many of the potent medicines used need monitoring
  because of long term effects, some GPs may be
  unaware of this.
• Each time the patient visits the clinic they may
  see a different doctor.

4
Pharmacy Interventions 1

• Hospital pharmacists are a good source of
  information on medicines so they can re-enforce
  the advice given by the prescribers. Better
  information means patients are more likely to
  take their medicine appropriately.
• Back it up with written information (medicine
  leaflets)
• Discuss side effects and their relative
  seriousness
• Discuss alternative forms/taste for easier
  swallowing
• Discuss alternative timings to fit life style and
  therapeutic levels

5
Pharmacy Interventions 2

• Alert medical staff when they find interactions
  or medicine regimes that could be better or need
  reviewing.
• Managing the TDM means we can have consistently
  useful plasma level results.
• With the frequent turnover of hospital doctors
  the pharmacy is often where the patient sees the
  same people on a regular basis.

6
Pharmacy Interventions 3

• PLD often have physical problems such as
  Dysphagia and so are fed via a PEG. Pharmacists
  have information on medicines so they work with
  carers, dietitians, physios and SaLT to alleviate
  these problems.
• Pharmacists are the ideal people to do medication
  histories when patients have longstanding
  intractable epilepsy to see if we can find any
  patterns.

7
Pharmaceutics 1

• The old art of presenting medication in the most
  appropriate, safe, accurate and easy to use form.
• Midazolam a benzodiazepine for status, only
  licensed as an injection for pre-med for
  sedation. Now being used as an alternative to
  rectal diazepam as a more dignified treatment in
  the community.
• Problems to overcome-

8
Pharmaceutics 2

• Elegant presentation
• Easy to use in distressing situations
• Accurate dose easy to administer for carers
• Stable presentation
• Long shelf life
• Small volume quickly absorbed
• Palatable-pleasant taste if possible
• Reliable absorption and effects

9
Rescue Medicationin the Community

• Rectal Diazepam
• Benzodiazepine beware of respiratory depression
  in large doses
• Can cause embarrassment to administer
• Can have idiosyncratic effect with some people
• Buccal Midazolam
• Benzodiazepine quick acting small dose
• Ease to administer
• Unlicensed use

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Pharmacists Rôle

• A valuable source of information to help promote
  seamless care for all patients.
• Provide the medication required in the best
  available form.